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Midwives: Job Description, Requirements, Certification, And More

April 1, 2019

Pregnant women have a myriad of plans and choices to make. From choosing a name to the paint scheme and theme of the nursery, each option is carefully analyzed. The mother-to-be wants everything to be perfect.

When it comes to giving birth, women are encouraged to decide on a birth plan to sets forth their wishes for the labor and delivery experience. Who do you want to be by your side holding your hand, and who do want delivering your baby?

While most women opt for the traditional obstetrician, some choose to have a midwife. Midwives are valuable resources and caregivers during pregnancy and childbirth. What is a midwife? Below are some answers and specifications on what goes into becoming a midwife and what that function is.

What Is A Midwife?

A midwife is defined as a person who is educated to assist in childbirth. The practice goes back to ancient times when a woman who had given birth would attend to and help other women give birth. In Ancient Greece, a woman had to be a mother herself to help others deliver babies.

As the name implies, historically women have practiced midwifery. Men used to step in when surgery was needed. This is believed to be the how obstetrics first began. Men who were barbers, or rudimentary doctors, created instruments to help in childbirth and perform surgical intervention in times of distress and need.

Women were typically not barbers and therefore remained in the role of midwife. In the United States, modern medicine started in the late 19th century. It was about this same time that a general shift away from utilizing midwives for delivering babies began. What happened that a practice in use for hundreds of years suddenly started to die out?

The overwhelming cause of this change was due to the advent of preventative medicine, which was obviously a good thing in general. It advocated that women should be followed by a doctor utilizing certain standard clinical practices before a crisis happened. It was also about this time anesthesia was invented.

Doctors began using drugs to ease the pain of labor and childbirth making women more comfortable and the experience less difficult. Twilight sleep became the standard in childbirth. Women would labor, and right before delivery, they would be put into a light sleep while doctors used tools such as forceps to deliver the baby.

It was at this time the episiotomy became a normal part of the delivery experience. It was one factor that made childbirth less dangerous for both mother and baby. Because midwives would typically deliver children in the home, which of course did not have these medical interventions, the entire process started becoming obsolete.

Doctors reminded women of the risks associated with home births. As a result, women began flocking to hospitals to give birth. This became the standard birthing practice in America from that point on as women started seeing obstetricians before the baby was born to monitor the pregnancy.

Even though the government set forth guidelines for midwifery in the 1920s making it regulated and putting in place education and practice requirements, many women were already predisposed to utilizing obstetricians. Infant and mother mortality rates had fallen. People believed in the doctors and their methods more than ever. Midwives practiced far less, but still, they remained.

What Do Midwives Do Now?

As modern medicine has evolved, so too has the role and function of a midwife. The choice between using a midwife or an obstetrician comes down to the type of prenatal and birth experience a mother wants. Some women want a more personalized and natural birth.

Typically, midwives are still called upon in these instances. They bridge the gap between patient and doctor. In fact, these days some obstetrician-gynecologists also employ a midwife on staff, giving women the best of both worlds in the intimate pregnancy and birth experience while also having a licensed medical doctor on hand in case the situation calls for intervention.

Who Can Be A Midwife?

Now that midwifery is regulated throughout the country, there are two main options for becoming one:

The CSM

The most common midwife is a registered nurse who becomes a certified midwife by exam, known as a CSM. A CSM is able to practice in all 50 states and provide preventative care for women, as well as prenatal and post-natal care.

The CM

Another path to midwifery is a non-nurse who has a bachelor's degree in a health-related field, has completed a midwifery program and has passed the certification exam, which will garner a certified midwife or CM designation. People who have the CM certification are not able to practice in every state.

What Can A Midwife Do?

The fundamentals of a midwife have not changed at all. They are present to deliver personal, hands-on care to mom and baby. Midwives typically practice by touch. Prenatally, they use basic hands-on techniques to monitor the baby, check fetal growth and perform pelvic exams to check the progress of dilation.

While many midwives now practice in doctor's offices and hospitals, they still try to utilize these basic practices when caring for a pregnant woman. This is not to say that a midwife could not or would not do an ultrasound to look in on baby from time to time.

An ultrasound is usually still performed, but it is limited as opposed to the number obstetricians perform. Of course, if the patient requests more than one ultrasound be performed, a midwife would most likely grant that request. The primary function of a midwife is to provide prenatal care through delivery with as little medical intervention as possible.

Some women want a natural birth experience with no drugs, fetal monitoring or medical interference such as episiotomies. Midwives provide this and also give more personalized care leading up to birth and after. Many women feel like a midwife is a sister holding their hand throughout a complicated and trying process.

This isn't to say a doctor cannot do the same, but more often than not, doctors have a very rigid and clinical view on childbirth that includes precautionary measures, such as fetal monitoring, and delivery assistance, such as epidurals, episiotomies, forceps or vacuum extraction.

There is a general stigma surrounding midwives that they are free-spirited, anti-medicine charlatans who help women give birth in bathtubs or at home. While the latter is true (they can and do travel to help with homebirths), an overwhelming number of midwife-assisted births happen in a hospital or a birthing center.

A birthing center is not as clinical as a hospital, yet has all the resources at hand to provide emergency intervention if necessary. Most birthing centers are set up to look and feel like homes. They center completely on strict adherence to the mother's birth plan.

Extended family involvement in labor and delivery is encouraged. Birthing centers advocate family support and participation to make the birthing process as intimate and unique as possible.

Who Can Use A Midwife?

Any woman who is considered "low risk" can utilize the services of a midwife. This usually involves women who have not had any issues in a previous pregnancy and delivery or first-time mothers who have demonstrated no medical history that would indicate complications during pregnancy and birth.

Of course, situations can and do arise that call for medical intervention during delivery. If a woman has labored too long and is not progressing, if there are signs of fetal distress, if the mother is showing signs of trouble herself, then it becomes necessary for a medical doctor to step in and perform a cesarean section.

Since these emergencies can happen with little or no warning, giving birth in a hospital or birthing center is vital. Women who opt to give birth at home run the risk of fetal or maternal death due to an inability to get to the hospital in the middle of a crisis.

Do Midwives Accept Insurance?

Most insurance companies do allow midwives to take insurance if he or she has the CSM and in some instances the CM designation. Your prenatal and birth are covered as long as you give birth in a hospital or birthing center.

Most insurance companies do not pay for home births because of the liability associated with them. If you are interested in utilizing a midwife and plan on using insurance, be sure to check your specific coverage to ensure you and your baby will be covered.

Are Midwives Only For Child Birth?

Midwives are not only available to women during pregnancy. They are also able to perform annual exams including pap smears and attend to reproductive health before and after pregnancy. They also monitor and address:

Emotional and mental health

Diet and nutrition

Birth control

STD prevention and education

Midwives perform all the services and tests obstetricians perform, they just usually do so in a more intimate and personalized setting. Childbirth is a natural, physiological process that has remained the same since the beginning of time.

What has changed is the medical care and support available throughout the pregnancy and through birth. When deciding what kind of birth you want to have, there are many options to consider. Midwives offer a more personalized birth experience, preferring natural methods of pain relief and fetal monitoring during labor and delivery.

A woman who is expected to have a healthy and low-risk pregnancy have the option to utilize a midwife to help her through this challenging, beautiful and life-changing experience.